09. Precautions & Contraindications
Terms in this set (59)
Anterior Cruciate Ligament Knee Injuries - Definition
• Partial or full tear of the ACL caused most commonly by a blow to the lateral side of the knee resulting in a valgus force.
• This mechanism of injury usually results in additional injuries to the Medial Collateral Ligament and the Medial Meniscus (the unhappy triad).
• Rotation of the femur on a planted tibia/foot is a common mechanism of injury to the ACL as well.
Anterior Cruciate Ligament Knee Injuries - Contraindications Without Surgical Repair
• Open chain terminal knee extension (from 60° to 0°) with resistance to the distal leg.
• Squatting between 60° - 90° causes increased anterior translation of the tibia on the femur and subsequent stress to the ACL.
Anterior Cruciate Ligament Knee Injuries - Contraindications With Surgical Repair
• Maximum protection phase - up to 10 weeks should be handled by a physical therapist or licensed medical professional
• Minimum protection phase is 10-24 weeks. Avoid pulling the tibia forward on the femur manually and avoid open chain high resistance or terminal knee extension exercises. (Avoid Feet in Straps or Leg Spring work).
Facet Joint Syndrome - Definition
• Characterized by a segmental hypomobility (facet look) causing secondary hypermobile segments with pain and referral.
Facet Joint Syndrome - Symptoms
Often occurs with or because of disc degeneration. Usually painful with extension, especially combined with rotation and sidebending.
Facet Joint Syndrome - Contraindications
Avoid extension of the spine.
Herniated Nucleus Pulposis -HNP
(Herniated or Bulging Disc) - Definition
Annular fibers weakened, nucleus loses volume and narrows.
3 Stages of Herniated Nucleus Pulposis -HNP
1) Disc Bulge:
a. posterior annular fibers tear due to repeated loading in flexion and/or flexion and rotation.
b. nucleus may bulge sufficiently to cause pressure on the Posterior Longitudinal Ligament (PLL), causing pain.
2) Prolapsed Disc (extruded nucleus): outer annulus and PLL fibers give way, allowing nucleus to bulge into spinal cord.
3) Sequestration: nuclear material has separated from the nucleus allowing it to be free in the neural canal.
Herniated Nucleus Pulposis -HNP - Symptoms
peripheral pain or numbness/tingling in buttocks, thigh, calf or toe; may present with a lateral shift; in more severe stages, may present with lower extremity weakness and/or loss of deep tendon reflexes.
Herniated Nucleus Pulposis -HNP - Contraindications
• In acute stage or when any symptoms are present - avoid all exercises that include spinal flexion or vertical loading (seated, standing or inverted positions) of the spine.
• Avoid any exercise that involves a straight leg raise or strong spinal rotation.
Spondylolisthesis - Definition
An instability most often at L5-S1 or L4-L5 due to a defect in the laminae causing anterior vertebral displacement.
Spondylolisthesis - Symptoms
• Typically aggravated by extension activity.
• Minor injury causes acute pain with diffuse radiation into buttocks.
• Major injuries cause fractures in the laminae and can also cause serious spinal cord injuries.
Spondylolisthesis - Contraindications
Always avoid extension of the spine.
Stenosis - Definition
• Narrowing of the spinal canal (central stenosis) or nerve root canals (lateral stenosis), compromising the spinal cord or nerve roots.
• Usually occurs in the lumbar spine but can also occur in the cervical and thoracic spine.
Stenosis - Symptoms
Symptoms typically aggravated by extension include back pain, tingling, motor deficits (transient) and intermittent pain in one or both legs which is made worse by standing or walking.
Stenosis - Contraindications
Always avoid extension of the spine.
Total Hip Replacement - Definition
Acetabulum and/or Femoral Head removed and replaced with mechanical components due to fracture or osteoarthritis.
Total Hip Replacement - Contraindications
• Posterior Approach: permanently avoid Hip Flexion above 90°, Hip Adduction and Internal Rotation. Females should avoid sitting in a crossed leg position, which can frequently cause dislocation of the hip joint which would require surgical repair.
• Anterior Approach: permanently avoid all hip extension, abduction and external rotation. These positions often cause dislocation of the hip joint requiring surgical repair.
Adhesive Capsulitis (Frozen Shoulder) - Definition
Capsular tightening of the glenohumeral joint
Adhesive Capsulitis (Frozen Shoulder) - Precautions
Avoid aggressive stretching of the shoulder joint and endrange loading of the shoulder joint.
Carpal Tunnel Syndrome - Definition
the sensory loss and motor weakness that occurs when the median nerve is compressed in the carpal tunnel
Carpal Tunnel Syndrome - Symptoms
increasing pain in the hand that comes with repetitive use, weakness in the thenar muscles, and/or sensory loss in the thumb or 1st and 2nd fingers.
Carpal Tunnel Syndrome - Precautions
Avoid resistance training of the upper body, wrist flexion, forearm supination and pressure to the base of the palm that occurs in weightbearing during periods of flare-up.
Plantar Fasciitis - Definition
A chronic inflammatory syndrome characterized by pain on the bottom of the heel and/or arch. Although the pain usually occurs in the heel, it can radiate throughout the bottom of the foot toward the toes.
Plantar Fasciitis - Symptoms
Most commonly occurs in the morning with weightbearing. Pain also occurs with the onset of activity such as walking and running. This pain may decrease as activity progresses, but it usually returns after resting and then when activity resumes. In severe cases, the pain may occur with any kind of weight bearing. It is common in runners and dancers, along with individuals who are overweight or have had a sudden gain in body weight, who increase their activity level.
Plantar Fasciitis - Precautions
Any weightbearing exercise that causes increase in heel or arch pain or shortens the calf muscles as in plantar flexion of the foot.
Rotator Cuff Impingement - Definition
Compression most often of the supraspinatus tendon, infraspinatus tendon or subacromial bursa against the acromion of the scapula due to compromise of the subacromial space.
Rotator Cuff Impingement - Symptoms
Pain in glenohumeral joint, deltoid, or bicipital tendon.
Rotator Cuff Impingement - Precautions
Avoid overhead shoulder positions, internal rotation or endrange loading of the shoulder joint combined with abduction "impingement position".
Thoracic Outlet Syndrome - Definition
Complex syndrome with 5 main entrapment locations (brachial plexus, subclavian artery and subclavian vein):
1. Anterior Scalene tightness - causes compression of the brachial plexus between the anterior and middle scalene muscles.
2. Costoclavicular approximation - compression in the space between the clavicle and the first rib.
3. Pectoralis minor tightness - compression beneath the tendon of the pectoralis minor under the coracoid process.
4. Presence of a cervical rib or elevated 1st rib causes entrapement of the brachial plexus.
5. Inferior glenohumeral joint capsular tightness.
Thoracic Outlet Syndrome - Symptoms
numbness, tingling, ablation of pulse, coldness or pain in affected upper extremity
Thoracic Outlet Syndrome - Precautions
Avoid any exercises (especially upper body) that produce symptoms.
Cardiovascular Disease - Definition
Any disease of the heart and blood vessels, including coronary heart disease, cardiomyopathy (congestive heart failure, myocardial infarction (heart attack), stroke, hypertension (high blood pressure), arrhythmia (irregular heartbeat), rheumatic heart disease and atherosclerosis (hardening of the arteries), peripheral vascular disease, congenital heart disease, endocarditis.
Cardiovascular Disease - Precautions
• Be sure that client consumes water before, during and after Pilates sessions. client should not exercise in hot tempuratures (rooms over 80°). Check client's feet who have peripheral vascular disease before and after every session for cuts, blisters or signs of infection due to decreased sensation of the feet (they may also need to wear shoes during their sessions in there are cuts, blisters or signs of infection).
If the foot wounds are severe the client should avoid weightbearing exercise altogether.
• With hypertension, avoid inversions and high-intensity or heavy resistance exercises and instruct clients to move slowly when rising from a supine, side-lying or prone position due to increased susceptibility to orthostatic hypotension.
Cardiovascular Disease - Contraindications
Discontinue exercise if any known symptoms or unsusual symptoms occur. If symptoms persist, activate the Emergency Medical System (call 911.)
Heart Attack Warning Signs
• Uncomfortable pressure, squeezing, fullness or pain in the center of the chest that lasts more than a few minutes or goes away and comes back
• Pain or discomfort in one or both arms, the back, neck, jaw or shomach
• Shortness of breath along with, or before, chest discomfort
• Other signs such as breaking out in a cold sweat, nausea, or light headedness
Stroke Warning Signs
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause
Chronic Fatique Syndrome - Definition
Debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity.
Chronic Fatique Syndrome - Symptoms
Suffers typically have four or more of the following symptoms:
• substantial impairment in short-term memory or concentration
• sore throat
• tender lymph nodes
• muscle pain
• multi-joint pain without swelling or redness
• headaches of a new type, patter or severity
• sleep that does not refresh
• post-exertional malaise (period of intense exhaustion) lasting
The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue.
Chronic Fatique Syndrome - Precautions
People with this require an appropriate amount of physical activity for physical and emotional well being and need to be paced carefully. If the client develops new symptoms or has more than 24 hours of soreness following Pilates exercise
Fibromyalgia - Definition
Chronic pain illness which is characterized by widespread musclskeletal aches, pain and stiffness, soft tissue tenderness or "tender points" that are painful when pressure is applied. Clients have "exercise intolerance" (hypersensitivity) and often feel worse after exercising.
Fibromyalgia - Precautions
Exercises for client with this must by slow, sustained and low-resistance.
Diabetes - Definition
Characterized by reduced insulin secretion or reduced sensitivity to insulin which causes abnormalities of several body systems that, left untreated, can be fatal.
Diabetes - Symptoms
Clammy, cold, sweating, shaking, nausea, heart rate increase, loss of consciousness
Diabetes - Precautions
1. Client should perform a similar exercise routine every day within one hour of consuming a meal or snack.
2. Client should always carry a rapid-acting carbohydrate such as juice or candy in case they develop hypoglycemia.
3. Clients should not inject insulin into the primary muscle groups before exercise, because it will absorb too quickly, resulting in hypoglycemia.
4. Avoid exercise during periods of peak insulin activity.
5. Check clients feet before and after every session for cuts, blister or signs of infection due to decreased sensation of the feet.
6. Physicians may encourage these clients to check their blood glucose levels before and after exercise so that exercise is stopped if pre-exercise blood glucose is below 100mg/dL or greater than 300 mg/dL.
7. Exercise program should be performed consistently so that a regular pattern of insulin dosage and diet can be maintained.
Gastric Reflux- Definition
• The backward flow of stomach acid contents into the esophagus. Also called Gastroesophageal Reflux Disease (GERD), esophageal reflex or gastroesophageal reful.
• Gastric reflux in injury to the esophagus that comes from chronic exposure of the esophagus to acid coming up from the stomach (reflux).
• In contrast, heatburn is the symptom of acid in the esophagus, characterized by a burning discomfort behind the sternum.
Gastric Reflux - Precautions
Avoid food consumption 2 hours before exercise, monitor supine positions, avoid all inversions.
Glaucoma - Definition
• A disease in which the normal fluid pressure inside the eyes slowly rises, leading to vision loss or blindness. An eye disease associated with increased pressure within the eye. Glaucoma can damage the optic nerve and cause impaired vision and blindness.
• Aerobic exercise lowers eye pressure, a major risk factor for glaucoma.
• Regular aerobic exercise can help keep fluid flowing to and from the eye, thereby avoiding a buildup of pressure in the eye compartment.
Glaucoma - Contraindications
Partial and full inversions, valsalva maneuvers (moderately forceful attempted exhalation against a closed airway).
Multiple Sclerosis - Definition
An autoimmune disease that affects the central nervous system (CNS). The myelin sheath that coats the nerves is damaged in multiple areas, leaving scar tissue called sclerosis, plaques or lesions.
When myelin or the nerve fiber is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, and this produces the various symptoms of MS.
Multiple Sclerosis - Symptoms
Balance and coordination deficits, dizziness and vertigo, temperature sensitivity, depression, fatigue, memory/attention/cognnitive deficits, numbness, pain, sexual dysfunction, spacticity, vision problems and bladder and bowel dysfunction.
Multiple Sclerosis - Precautions
Avoid over-exertion, heavy resistance training, fatigue, extreme hot or cold environment. Guard carefully with balance exercises.
Osteoarthritis - Definition
Slow, progressive degenerative of joint structures which can lead to loss of mobility, chronic pain, deformity and loss of function.
Develops slowly in response to mechanical stress.
Results in cartilage degradation, altered joint architecture, osteophte formation, affects only few joints (L or R), commonly characterized by morning stiffness lasting only 30 minutes.
Increasing joint pain with weightbearing and strenuous activity.
Unlike rheumatoid arthritis there are no systemic effects.
Osteoarthritis - Precautions
Avoid high impact exercises, low-intensity frequent exercise in general.
Reduce exercise intensity and duration during periods of increased inflammation or pain, extend the warm-up and cool-down periods, modify the intensity and duration of exercise according to motion at least once a day to maintain mobility and decrease stiffness.
If pain increases during or following an exercise session lasting more then 2 hours after the session, suggest 1-2 days of rest and decrease the intensity of future exercise session.
Clients should work up to the point of pain, but not past it.
Osteoporosis - Definition
Skeletal disease characterized by low bone mass and deterioration of bone tissue, especially affecting the vertebrae, neck of the femur and wrist bones. This leads to bone fragility and increased fracture risks.
• Osteopenia - mildly reduced bone mass (1.0 - 2.5 standard deviations below mean). 2x risk fracture. About 10-25% bone loss.
• Osteoporosis - siginificantly reduced bone mass (2.5 or more standard deviations below mean). 4-8x risk fracture. More than 25% bone loss.
Osteoporosis - Contraindications
• Avoid flexion, rotation and side bending of the spine.
• Absolutely no spine flexion in any position for Osteoporosis and Oteopenia. NO CRUNCHES, Hundred position, Rollups or Rollerover positions
• Avoid strong external or internal rotation forces at the hip joint.
• Neutral and extension only (may do supine posterior pelvic tilts to increase abdominal strength).
• Focus on thoracic extension.
Pregnancy - Contraindications
• During all trimesters, avoid moderate to maximal contractions of the adductor muscles due to softening of the pubic symphysis joint. For example: Horseback on the Barrel or Reformer, Light Springs Side Splits on Reformer, strong Circle work.
• Avoid inversions in 2nd and 3rd trimesters of pregnancy and post-partum.
• Avoid supine positions after 1st trimester. Working abdominals in any position except supine is permitted. Palpate Linea Alba to check for diastasis recti or teach client to check for it. Modify abdominal work and oblique work until diastasis bulge is under control.
•Ask client to report any dizziness, nausea, vision distrubances, headache, lightheadedness, vaginal blood, fluid loss, chest pain, muscle weakness, calf pain or swelling, uterine contractions or decreased fetal movement. These might be signs of vascular compromise to the inferior vena cava and/or aorta and fetus.
Unusual symptoms may also be signs of miscarriage. Immediately have client consult their healthcare practitioner if any of the above symptoms occur.
Rheumatoid Arthritis - Definition
Chronic inflammatory systemic disease affecting the connective tissue. The onset and progression vary from mild joint symptoms with aching and stiffness to abrupt swelling, stiffness and progressive deformity.
Inflammatory changes occur in the synovial membrane, articular cartilage and tendon sheaths.
Rheumatoid Arthritis - Precautions
During periods of exacerbation, avoid endrange stretching to swollen joints and heavy resistance exercises. Avoid exercising to the point of exhaustion or extreme fatigue.
YOU MIGHT ALSO LIKE...
Medical Surgical Nursing | Picmonic Nursing Guide
ACE GFI 2016: Chap. 11 - Making Participant Safety a Priority
Upper Extremities Midterm NYCC Marchese
Injuries Of the Foot, ankle and lower leg, knee, and hip
OTHER SETS BY THIS CREATOR
30. Chair Levels
00. IMPORTANT - Joining this class
13. Mat - Sequencing from 'Return to Life'
07. Postural Patterns & Dynamic Assessment
THIS SET IS OFTEN IN FOLDERS WITH...
01. Scope of Practice - Ethics
03. Bones, Joints, Cartilage, Connective Tissue & Movements
02. The Pilates Philosophy - Copied material
06. Postural Views